No description available.

Thesis (M Med(Otorhinolaryngology)) -- University of Limpopo, 2011. / Background: Tonsillectomy is one of the commonest operations performed by ENT surgeons. Pain, haemorrhage, delayed feeding and resumption of normal activities are common morbidities. Different groups of analgesics are used to reduce these morbidities. Objective: We examined the effectiveness of the use of three analgesics, some in combinations in reducing these morbidities. The primary outcome measures were pain, resumption of normal diet, resumption of normal physical activities and secondary haemorrhage. The secondary outcome was comparison of pain profile of children and adults. Methods: A prospective randomized double blind controlled study. Subjects were recruited and randomized into three study groups; group A (Paracetamol & Ibuprofen), group B (Ibuprofen) and group C (Paracetamol, Ibuprofen & Tilidine). A diathermy dissection technique was used on all patients in removing tonsils. Pain was measured using a patient morbidity scoring form (PMS) as well as the Smiley scale. The care givers for children and adult patients recorded all other events. Results: Sixty five patients were recruited, 30 were in group A, 20 in group B and 15 in group C. There were 36 females and 29 males. The youngest patient was 4 years of age and the oldest was 38 years. The mean number of days prior to resuming normal daily activities for groups A, B and C was 9.27, 10.60 and 7.67 respectively. Group C patients started their daily activities earlier than those in group B (p≤0.05). The average number of days to stop analgesic use was 12.3, 13.3 and 10.6 for groups A, B and C respectively. Patients in group C stopped using analgesics earlier than group B patients (p≤0.05). There was no statistically significant difference in PMS scores, resumption of normal diet, post-tonsillectomy haemorrhage as well as pain profiles of adults and children. Conclusion: Paracetamol-ibuprofen-tilidine combination appears to be more effective than either paracetamol-ibuprofen combination or ibuprofen in the first two weeks in the treatment of post tonsillectomy pain (p>0.05), however, further studies will have to be carried out to confirm this. Patients treated with a paracetamol-ibuprofen-tilidine combination appear to stop medication and return to their normal daily activities much earlier (p ≤ 0.05). Minor haemorrhage from the use of ibuprofen following tonsillectomy was not a cause for concern.

Tonsillectomy is one of the most commonly performed surgeries in North America. Guidelines exist for surgical candidacy for pediatric patients, but to date, there exists significant controversy and no clear guidelines advising physicians on treating pain post-tonsillectomy. Pain is the most frequent and potentially morbid complication of tonsillectomy, as it triggers return visits to physicians and hospitals following surgery, and can result in the need for hospital admission for hydration and pain control. In fact, a main point of controversy surrounds the use of a large class of analgesics known as non-steroidal anti-inflammatory drugs (NSAIDs), due to the potential for increased risk of bleeding as a result of their anti-platelet activity. However, NSAIDs have been shown to have a notable analgesic benefit in other surgical fields without conferring a significant bleeding risk. Moreover, they are known for their opioid-sparing effect, which is favored due to the many side-effects of opioids. Therefore, we undertook a systematic review of the literature to investigate the question of analgesic benefit for NSAIDs compared to other analgesics, and found that they were not different than opioids at treating post-tonsillectomy pain. However, the evidence available to answer this question was often flawed, warranting further investigation into this question. We were also especially interested in investigating commonly used analgesics such as ibuprofen and acetaminophen, so we devised a protocol that included these two medications. This protocol compares ibuprofen and acetaminophen to acetaminophen alone and seeks to show a significant opioid-sparing effect for ibuprofen. Ultimately, this topic is important because of the frequency with which tonsillectomies are performed and the importance of pain control following this procedure. / Thesis / Master of Science (MSc) / Tonsillectomy is the surgery that completely removes the tonsil from the throat, and many children and adults undergo this procedure for various reasons including infections, sleeping problems and other. This surgery has several side effects including pain, dehydration and bleeding. Pain is the most frequent of all these side effects, and can result in significant disturbances in the recovery experience, as well as cause the patient to require hospital visits and admission. Therefore pain control is important, and can be achieved incorporating medications such as non-steroidal anti-inflammatory drugs into the post-operative analgesic regimen. We investigated the role that these medications can play in relieving pain in this setting, and found that these are no different than opioids, such as morphine and codeine, the latter of which have many side-effects including breathing problems, constipation, itchiness, nausea, and others. However, there wasn't enough evidence to make definitive conclusions regarding the amount of opioids that can be avoided with the use of non-steroidal anti-inflammatory drug. Therefore, we designed a protocol for a randomized study to better understand this area that is so far little understood. The results of this study could help optimize pain control measures following tonsillectomy, and change the practice of surgeons favoring an evidence-based approach.

Hitzschke, Maria: Der Einsatz von FloSeal® bei der Blutstillung im Rahmen der Tonsillektomie Universität Leipzig, Dissertation 76 S., 79 Lit., 14 Abb., 17 Tab. Referat: Die Tonsillektomie ist eine der häufigsten operativen Eingriffe in der HNO-Heilkunde in Deutschland. Trotz neuer Techniken der Präparation und Blutstillung kann es dabei zu teilweise lebensbedrohlichen Komplikationen kommen. Ziel der vorliegenden randomisierten, monozentrischen Einfachblindstudie, welche auf prospektiv erfassten Patientendaten beruht, war es zu prüfen, ob der Einsatz einer Gelatine-Thrombin-Matrix (FloSeal®) bei der Blutstillung im Rahmen der Tonsillektomie einen Einfluss auf die Operationsdauer, den postoperativen Schmerzverlauf, die Wundheilung oder auf die Nachblutungsrate im Vergleich zur konventionellen elektrischen Blutstillungstechnik aufweist. Im Ergebnis konnten die Operationszeiten, vor allem für erfahrene Operateure, durch FloSeal® nicht verkürzt werden. Die bessere Planbarkeit der Operationsdauer durch die vordefinierte Blutstillungszeit bei der FloSeal®-Anwendung ist aber vor allem für unerfahrene Operateure von Bedeutung. Die postoperativen Schmerzen ab dem 4. postoperativen Tag waren in der FloSeal®-Gruppe geringer, auch die Schmerzdauer konnte um knapp 3 Tage verkürzt werden. Dies ist am ehesten auf eine verbesserte Wundheilung bei den mittels FloSeal® behandelten Patienten zurückzuführen, die sich in den stets signifikant geringeren Wundbelägen widerspiegelte. Der verminderte Einsatz der bipolaren Koagulation durch die Anwendung von FloSeal® konnte jedoch nicht zu einer signifikanten Reduktion der Nachblutungsrate führen. Trotz ermittelter Vorteile des Einsatzes von FloSeal® im Rahmen der Tonsillektomie sollte FloSeal® aber aus unserer Sicht den Patienten mit diffusen flächigen Blutungen im Rahmen einer Tonsillektomie vorbehalten bleiben, bei denen eine großflächige bipolare Koagulation die postoperative Morbidität deutlich steigern würde.

Abstract Seventy-eight prepubertal children 3 to 10 years old (mean age 5,67 years, range 2.4 - 10.5 years), with symptoms suggestive of obstructive sleep apnea syndrome (OSAS) were studied. Based on overnight polysomnography (PSG) results, 32 children were classified as having OSAS, whereas 46 children were considered as primary snorers (PSs'), when an obstructive apnea-hypopnea index (AHIO) of over one was considered abnormal. Symptoms, signs and findings in these two groups were compared in a cross-sectional study. Fifty-eight of the children were retrieved for a follow-up visit, which was scheduled six months from the first visit. The children with an initial AHIO of 2 or over (n = 21) had been subjected to adenotonsillectomy swiftly after the first visit, whereas the others (n = 37) were observed without intervention. The changes in symptoms, signs and findings were analysed within and between these groups. Relative risk (RR) ratios were calculated in order to find clinical symptoms and signs predicting OSAS in snoring children. Observed apneas, restless sleep, constant snoring and tonsillar hypertrophy were significantly associated with an increased risk of OSAS. Dental arch measurements indicated that AHIO was significantly associated with the amount of overjet, suggesting that altered breathing may affect the dentofacial morphology. Nasalance measurements revealed no group differences between the OSAS children and PSs'. Adenotonsillectomy had no significant influence on the nasalence scores. Measurements of nasalance seem to contribute little to the diagnostics of OSAS in children. At the first visit the mean circulating concentrations of insulin-like growth factor-1 (IGF-1) were of the same magnitude in the OSAS children, the PSs' and the age-matched control group, but both the OSAS children and the PSs' had lower IGF-binding protein-3 (IGFBP-3) concentrations than the control subjects. At the second visit a significant increase of the peripheral concentrations of IGF-1 and IGFBP-3, along with increases in weight for height and BMI were observed in the surgically treated children, whose respiratory parameters and symptoms had improved highly significantly, as well. These results indicate that the growth of children with obstructed nighttime breathing is potentially affected through impaired growth hormone secretion. None of the primary snorers developed OSAS during the observation period, which finding suggests a favorable prognosis for primary snoring in children.

No description available.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 5 uppsatser.

Tonsillektomi är en av de vanligast utförda operationerna på barn i världen och kan innebära en lång och smärtsam återhämtning. Syftet med denna studie var att belysa vilka upplevelser som framkom under återhämtningen efter tonsillektomi på barn. Metoden var en litteraturstudie där tolv vetenskapliga studier ingick. Resultatetvisade att halssmärta var den dominerande upplevelsen och varade i dagar till veckor. Att svälja gjorde smärtan värre. Analgetika gavs i för små eller för få doser för att ge tillräcklig smärtlindring. Smärtan påverkade barnens möjligheter att äta, dricka och sova. Barnen hade egna strategier att hantera smärtan. Utökadpreoperativ information gjorde föräldrar och barn tryggare och säkrare. Postoperativtuppföljningssamtal gav föräldrarna möjlighet att få upprepad information ochkänslomässigt stöd. Som slutsats är det viktigt med adekvat, anpassad och upprepadinformation till barn och föräldrar om återhämtningen. Detta för att skapa trygghet till barn och föräldrar samt göra barns återhämtning så lindrig och smärtfrisom möjligt. / Tonsillectomy is one of the most common paediatric surgery performed over theworld and the recovery can be long and painful. The aim of this study was to illustrate the experiences associated with recovery after tonsillectomy on children.The method was a literature review where twelve scientific studies were included.The results showed that throat pain was the most difficult experience which lasted for many days or weeks. When swallowing, the pain became more severe. The painkiller at home was given in to small or too rare doses to give enough pain release. The pain influenced the child’s possibility to eat, drink and sleep. Children had their own strategies to cope with the pain. Extended preoperative information made the parents and children feel secure and more comfortable. Postoperative telephone follow-up gave the parents a possibility to get repeated information and emotional support. As a conclusion it is important to give a more adequate, adaptive and repeated information about the recovery to the child and the parents. This will encourage the child and the parents and make the child´s recovery as comfortable and painless as possible.

No description available.

Crianças com aumento do volume de tonsilas palatinas e faríngeas, freqüentemente apresentam anormalidades respiratórias tais como roncar, respiração oral e apnéia do sono, assim como atraso no crescimento, alterações físicas e emocionais. Sabe-se que a obstrução de vias aéreas superiores e conseqüentemente a respiração oral podem resultar em problemas pulmonares. A obstrução de vias aéreas superiores também pode conduzir a alterações na mecânica respiratória e evoluir para alterações no equilíbrio das forças musculares, causando disfunções faciais, torácicas e dos eixos posturais. As alterações na função pulmonar (Pressão Inspiratória Máxima, Pressão Expiratória Máxima e Volume Pulmonar) foram avaliadas em 32 crianças (6-13 anos, M: F) com aumento do volume de tonsilas que seriam submetidas a cirurgia de Adenoamigdalectomia na Divisão de Otorrinolaringologia da Universidade de São Paulo. Todas as crianças foram avaliadas no pré e pósoperatório (3 e 6 meses) de adenotonsilectomia. A pressão Inspiratória e expiratória máxima foram medidas com o uso de um manovacuômetro. O volume pulmonar foi medido através do uso de um Inspirômetro de Incentivo infantil. Os perímetros torácicos e abdominais foram obtidos através de uma fita métrica comum. No pré-operatório os seguintes valores foram obtidos: pressão inspiratória máxima média de 24,72 cm/H2O, pressão expiratória máxima média de 37,50 cm/H2O, volume pulmonar médio de 682,81ml, perímetro torácico com média de 69,25cm e o perímetro abdominal com média de 67,50 cm. Todos os valores analisados apresentaram-se maiores no pós-operatório, sendo os resultados mais significantes a pressão inspiratória máxima com o valor de 28,62 cm/H2O no pós-operatório de 3 meses e 32,52 cm/H2O em seis meses. O volume pulmonar também apresentou um ganho de 265,47 ml no pós-operatório de seis meses em relação ao valor obtido no pré-operatório. Concluímos que a pressão inspiratória máxima apresentou um aumento significativo em seus valores no pós-operatório de 3 e 6 meses o que denota um ganho na força da musculatura respiratória inspiratória o que propiciou o aumento no volume pulmonar. Verificamos um aumento gradativo em todos os parâmetros estudados nos resultados obtidos no pós-operatório de 3 meses para os 6 meses. Os resultados comparativos entre os tamanhos das tonsilas (grau 3 e 4) não demonstraram diferença significativa. / Children with enlarged tonsils and pharynx, often exhibit respiratory abnormalities such as snoring, mouth breathing and sleep apnea, as well as delay in growth, physical and emotional changes. It is known that the upper airway obstruction and consequent mouth breathing may lead to lung problems. The obstruction of upper airway can also lead to changes in respiratory mechanics and evolve to changes in the balance of forces muscle, causing facial disorders, thoracic and axes posture. The changes in lung function (maximal inspiratory pressure, maximal expiratory pressure and lung volume) were evaluated in 32 children (6-13 years old, M: F) with enlarged tonsils who would be subjected to surgery for adenotonsillectomy at Division of Otorhinolaryngology, University of São Paulo. All children were evaluated in the preoperative and postoperative (3 and 6 months) of adenotonsillectomy. The maximal inspiratory and expiratory pressures were measured using a manometer. The lung volume was measured by using a volumetric incentive spirometer. The thoracic and abdominal perimeters were obtained through a common tape. Preoperatively the following values were obtained: mean maximal inspiratory pressure of 24.72 cm/H2O, mean maximal expiratory pressure of 37.50 cm/H2O, mean pulmonar volume of 682.81 ml. Mean girth of 69.25 cm and mean Abdominal Perimeter of 67.50 cm. All figures analyzed were higher in the postoperative period, and the more significant result was maximal inspiratory pressure with a value of 28.62 cm/H2O the postoperative 3-month and 32.52 cm/H2O in six months. The lung volume also showed a gain of 265.47 ml in the postoperative period of six months from the value obtained preoperatively. We conclude that the maximal inspiratory pressure showed a significant increase in their values in the postoperative period of 3 and 6 months which indicates a gain in respiratory muscle strength which allowed the increase in lung volume. Noticed a gradual increase in all parameters studied the results in the postoperative period of 3 months to 6 months. The comparative results between the size of tonsils (grade 3 and 4) showed no significant difference.